The deformation valgus of the thumb of the foot is so common that in medical practice, you can count more than four hundred options for the operational solution of this problem.Of course, not all interventions were the same success and completely resolved the problem of patients, therefore in modern practice, the most progressive options of intervention have remained, in which the chances of patient recovery are high.Today, Khalus Valgus’s operation focuses on the lowest invasiveness as possible in combination with a good therapeutic effect of the intervention.
Indications
Khalus Valgus is a problem not only for adults, but it can also appear in children.The formation of a cone on the leg of the thumb at the initial stage does not bother patients until a clear pain appears during walking, problems with the selection of shoes, periodic inflammation of the bone.At this stage, most patients try to relieve pain with folk methods.Various compresses and baths remain only the course of the disease and lead to the real solution of deformation valgus - surgical intervention.
The indications for the operation are:
- Increased pain in the thumb of the foot;
- Chronic inflammation, which cannot be stopped, constant swelling;
- Too bad the skin in the Valgus curvature (cracks, suppuration, ulcers);
- Pila valgus with a pronounced curvature of the thumb joint;
- the inability to help patients with conservative methods;
- the appearance of a lame process;
- Limit motor activity in the foot.
Doctors insist on the treatment of valgus the thumbs exclusively surgically, because most patients turn to the stage of the disease when it is not possible to correct the pathology in a conservative manner.At the same time, if you do not start treatment of the bone on the legs, this will ultimately lead to the redistribution of the load on other fingers, which is why the fingers will suffer and bend from the second to the fifth.It is only with a timely surgical intervention that such complications can be avoided.
Preparation of the intervention
During the operation for the deformation valgus of the joint of the thumb of the foot, a serious preparation is carried out in orthopedics.The patient performs all the necessary tests.The key is a blood test, according to the results of which it is important to exclude signs from the inflammatory process in the body.
In some cases, the standard list of analyzes can be completed by determining the level of hormones and markers for oncology if doctors suspect the development of a clever process in the foot.
A compulsory stage in orthopedic operations is a diagnosis of X -rays - During the study, the images are taken in two projections in order to determine the nature of the deformation and the severity of the pathological disorders.
In difficult cases, doctors can use a magnetic resonance or a computed tomography.Such a study gives more precise results.According to the analyzes, doctors decide how it will be preferable to carry out the operation.
Classification of surgical interventions
All operations carried out by Valgus can be divided into two large groups - an invasive operation and reconstructive interventions.The first type of surgical interventions on the foot is characterized by a low trauma.
The operations are used limited - only at the initial stage of the development of the disease, if the deformation is insignificant and in the presence of benign growth of cartilage, which is easily eliminated by surgery.In all other cases, unvasive operations do not solve patient problems.
Most of the poorly invasive interventions are carried out quickly and do not cause complications.The scars after such an operation are minimal.The doctor has two to three perforations, the length of which does not exceed 0.5 cm.After these operations, the skin is restored very quickly and the period of incapacity for work is up to two weeks.
During reconstructive interventions, the volume of damage to soft tissue is more significant.However, a huge more operations is that they help even eliminate a significant deformation of the legs and to help a severe curvature.The incision of the reconstructive intervention reaches up to four centimeters, it is located on the medial side of the foot.With such surgery, doctors completely restore the anatomical position of the thumb of the foot.
You can also consider operations according to the location they are carried out.Three groups of interventions are distinguished - on soft tissues, on bone tissue and combined surgery.When performing interventions on soft tissues, it is possible to eliminate the deformation of the valgus only if there is no deformation of the head of the bone more.During such an intervention, the doctor works exclusively with soft fabrics - tendons, muscles, bors.
With surgery on bone tissue, it is possible to correct the deformation of the second and third degrees.The intervention consists in depositing part of the bone or carrying out an osteotomy.With a combined operation, the intervention occurs both in soft tissues and in the bones.But the possibilities of such surgery are wider - doctors can simultaneously eliminate bone growth and make ligaments.
Operational techniques
Several operational techniques can be eliminated on the legs, each with its own advantages and is selected with certain indications.
McBride operation
With surgery, McBraid is carried out in the first inter-flood interval just at the heads.Using pliers, the doctor spreads soft tissues and cuts the inter-flood ligament, which is located on the surface.After that, the surgeon has access to the muscle tendon, which is responsible for the allocation of the first finger - it is mobilized and sewn by a special suture material - Vikril.
In addition, the doctor works with bones in the shape of Sesam, he crosses a deep package which is attached to the sesam -shaped bone, which is eliminated by its subluxation.Then, the capsule of the morenephalanx joint is dissected on the outer surface, after which the incision is practiced on the inner surface of the foot approximately 5 to 6 cm long, the nerve is released through it and it is diverted to the side.
The dissection of the capsule is made in the form of the English letter V, and its peak is directed towards the thumb.According to the bone and below, the hooks of the Homeman are removed under it, the growth of the cartilage on the head of the metatarsal bone are removed.If this is not done, patients in the future will feel pain in the joint.
In the future, the development of the operation can take place in two ways, depending on the need for osteotomy.With osteotomy, it is necessary to use a radius that will fix the tendon to bone fragments.At the final stage, an excess of fabric of the capsules is eliminated, the plastic with a certain tension of the tissues is carried out, after which the surgeon sews the edges of the wound and treats his surface.
Such a technique was proposed more than eight decades ago, but until today, the operation has not lost its relevance.So after the intervention, there is no relapse, after surgery, patients are recommended to wear special orthopedic shoes.
SERI technique
The operational technique of the mini-invasive technique of Seri was proposed in 1998 by the surgeon Cesare Faldini.Now it is also actively used in the surgical practice of doctors in many countries.It refers to low-traumatic procedures and is effective at the initial stage of the development of the disease and with a moderate valgus curvature of the foot, when the angle of deviation of the thumb of the foot does not exceed more than forty degrees.
REFERENCE!The operation is not carried out due to serious osteoarthritis.In addition, patients can refuse this type of intervention with the instability of the first metatarsophalangeal joint.
The foot operation is carried out under local anesthesia.The doctor takes an incision in the projection of the head of the bone more than thumb, opens the joint capsule, leads osteotomy with a special file or a chisel.In the process of such a procedure, you can obtain a new redistribution of the load on the distal part of the bone more.
In the surgery process, doctors use the Kirshner knitting needle to create the correct position of the thumb - they start in the medial side of the surface in the spindle direction, after which the doctor brings a finger in manual mode and defines it in the right position.The operation in the rehabilitation process requires wearing a gypsum dressing - it is applied for at least two weeks.The withdrawal of the radius is carried out after about 1-1.5 months.
Chevron technique
The chevron technique is used for minor deformations if the angle is less than 17 degrees.The main condition for implementing such an intervention is the lack of osteoarthritis and other serious changes that the valgus of the foot causes.
Operational treatment is carried out as follows - at the initial stage, the doctor cuts the skin just above the writing of the foot of the foot.The shortened connections and the joint capsule itself stand out.The generally degenerative changes in tissues and ligaments cause a thumb deformation.Bone corn on the joint is deleted using a chisel or a file.
On the metatarsal bone, an incision is carried out at the level of the head, it moves outside and is installed under the sesamoid bone.Then, using screws or threads, the phalanx is fixed and the capsule closes.After the operation, the titanium screws do not require withdrawal, but they eliminate the thread three months after surgery, if it is not necessary to do it earlier.
Scarf technique
In most patients, you can remove the bone from the leg using the scarf-oosteotomy.Such an operation is carried out with a moderate valgus deformation of the first finger of the foot.To date, the operation is the most universal method to treat the valgus, it has many advantages compared to other methods.
The positive aspects of the operation are as follows:
- In the process, it is possible not only to change, but also to turn the head of the bone more, which allows you to obtain a more progressive result than with other surgical interventions;
- The doctor can with insufficient value perform the extension procedure;
- With a varior deformation, you can move the bone on the medial side;
- To reduce the load on the inner part of the foot and the first area of the finger, you can move the bone a little and on the side;
- If necessary, you can shorten the length of the bone;
- When they say the joint, bone elements can be turned.
Surgical intervention is carried out under vertebral anesthesia.The surgeon inside the foot has a cut at the start of the finger at the start of the metatarsal bone.After that, an incision in the shape of a zigzag is practiced on the side of the bones of the first finger, after which the bone head is moved to the desired position, its angle changes.At the same time, the doctor changes the location of the tendons, which are attached to the thumb.
Then, a deformed articular capsule is separated from the outside and the bones are fixed in the position required using titanium screws.As a rule, the ties are not removed, if they do not bring any discomfort, then the patients, then the screws.Rehabilitation after the operation goes from three to six weeks.Immediately after the intervention, patients are recommended to wear an orthosis or a special tire, in which it is necessary to load the foot as soon as possible.The tire rushes all the time while the recovery period passes.
Laser intervention
The elimination of the deformation of the valgus with a laser is also possible, however, patients should not be highly expected for such a method of surgery.Although it is minimal and sweeter, it is used exclusively at the early stage of the development of the pathological process.
An undeniable advantage of surgical intervention is a small size incision, which doctors make near the most important point of the edge of the bone.After healing, such an injury is practically not noticeable, which allows you to restore the aesthetics of the foot as much as possible.With the use of a laser, doctors have the possibility of carrying out a limited intervention:
- The existectomy is carried out - using a laser, part of the cartilaginous growth is removed, which forms at the early stage of the Valgus;
- Makeing osteotomy with a large cut - during surgery, the proximal phalanx of the first finger is removed;
- Perform an arthroplasty of resection - the joint surfaces of the bone plus and part of the phalanx of the thumb are deleted.
Laser withdrawal is generally carried out in clinics where there is special equipment.Recovery after surgery is minimal - in a few weeks, patients can walk normally.
The only drawback of the laser intervention is that the incorrect position of the bone is not subject to correction, and that it only develops under the desired parameters.In this case, patients are threatened with relapses.
Arthrodesis
The operation to eliminate the valgus by Arthrodesis is used quite rarely, but sometimes it is the only way for patients to get rid of the big finger of the foot.The operation belongs to the most radical intervention methods.
With the help of such surgery, it is possible to remove the base from the phalanx of the first finger of the foot and fix the fingers with special screws.
IMPORTANT! During the operation, the main objective is achieved - eliminating deformation and giving the joint the correct position, but not all patients become comfortable after such surgery.
There are serious contraindications for the intervention:
- vascular atherosclerosis and other circulatory disorders;
- Diabetic foot;
- Polyneuropathy.
With arthritis and osteoarthritis, patients can also refuse surgery if the joints are very distorted, destroyed, constantly inflamed.In this case, patients will advise little invasive surgery.
Among the complications of surgical intervention, the following pathologies can arise severe pain, discomfort due to titanium fixing structures installed in the bone.Rehabilitation after the intervention lasts eight weeks.Walk in gypsum is only necessary within the first days following surgery - this is necessary to repair the elements.You can use a baroka boot.These are specially designed orthopedic shoes that will eliminate the load of the operated leg.
Criticism
If the patient has an operation to eliminate the valgus, he can read the opinions and discover what types of intervention are made and their efficiency.Here are some similar opinions:
"Last year, I had to finish the ballerina's career due to the deformation valgus of the finger. They made a scarf according to the method, it seems that everything went well, but the leg is still hurting."
"I have been suffering for a long time for a long time, but I did not dare to go to the operation. I was made a complex arthrodesis, the restoration took more than two and a half months, but after the operation, it has become much easier. Now, I can walk without a stick and not torment."
“The bone on my leg is hereditary - even my mother and my grandmother suffered from drop.I decided to do the operation as soon as the first signs appear.The operation used a laser, all additional growths have been deleted to me, now the leg has a normal appearance, but the doctors followed the possible relapses. ”
In most cases, valgus deformation operations allow a person to solve the bone problem on the finger.When the first signs of valgus appear, do not report treatment - the best results appear at the start of the development of the disease.